HUMERAL SHAFT
FRACTURES
Whenever a patient presents with a
possible humeral fracture, inspect the upper arm for swelling, ecchymosis,
deformity, and open wounds. Palpate the area of maximal tenderness, and assess
the joint above (shoulder) and below (elbow) for injury. Always perform a
thorough distal neurovascular examination. After a fracture of the humeral
shaft, the arm should be supported and immobilized.
When gross fracture
angulation occurs, emergency care personnel should restore overall alignment of
the arm by applying longitudinal traction. This is best accomplished with
conscious sedation of the patient to avoid patient guarding and muscle spasm
that may prevent adequate reduction of the fracture. Once the fracture is
reduced, someone must maintain alignment of the fracture manually while a
well-padded splint is applied to the arm to provide stability and maintain the
reduction. For humeral shaft fractures, a coaptation splint typically works
best. The entire injured limb can then be placed in a sling for added comfort.
Fracture Of Shaft Of Humerus
Fractures of the humeral shaft are
generally due to direct trauma and can present as different fracture patterns,
such as transverse, spiral or oblique, and comminuted. Nonsurgical treatment is
acceptable in most instances, but the choice of treatment is based on the type
and location of the fracture, concomitant injuries, and age and condition of
the patient. For closed fractures, a coaptation splint or a collar and a lightweight,
hanging arm cast may be placed initially. About 10 days after injury, when the
initial swelling has subsided, the patient is fitted with a fracture brace,
which allows the patient to exercise the hand, wrist, elbow, and shoulder while
maintaining fracture alignment.
Fractures of the humeral shaft usually
heal with no significant deformity and with excellent function. Surgical
fixation may be indicated for (1) segmental fractures that cannot be
satisfactorily aligned, (2) associated injuries or fractures of the elbow that
make early motion desirable or produce a floating elbow, (3) polytrauma that
requires several weeks of bed rest (fracture alignment may be difficult to
maintain if gravity cannot be used to help control it and surgical fixation can
help to mobilize the patient), (4) pathologic fractures, (5) open fractures,
(6) fractures associated with vascular injury, and (7) radial nerve palsy that
develops after reduction. Radial nerve palsy can be due to nerve entrapment in
the fracture site. This complication may necessitate surgical exploration and
decompression of the nerve. At the same time, open reduction and internal
fixation is performed to avoid further injury to the nerve by moving fracture
fragments.
Internal fixation usually utilizes a
compression plate. Intramedullary fixation may be performed, particularly in
the case of pathologic fractures. External fixators can be used for open
humeral shaft fractures. The usual indication is a large soft tissue wound that
requires frequent changes of dressing. External fixation allows access to the
wound while still maintaining satisfactory fracture alignment and position.
